C.D. Matthews

MORPHOLOGICAL AND FUNCTIONAL RELATIONS OF GRAAFIAN FOLLICLE GROWTH TO OVULATION IN WOMEN USING ULTRASONIC, LAPAROSCOPIC AND BIOCHEMICAL MEASUREMENTS

The daily growth rates of ovarian follicles were recorded ultrasonically for five days until ovulation in 56 spontaneously ovulating women and related to endocrine and clinical parameters. Over the 5‐day period, the average diameter of the follicle destined to ovulate increased from 12 to 23 mm, the second largest follicle from 6 to 12 mm, the third largest follicle from 5 to 9 mm and the fourth largest follicle from 4 to 8 mm. Similar but lesser growth rates occurred in the follicles in the contralateral ovary. Ovulation occurred within 24 hours of the luteinizing hormone (LH) peak, and the mean peak diameter of the ovulating follicle was 23.2±0.3 (SEM) mm, (range 18–29 mm) before ovulation, and subsequent luteal function was judged to be normal. Follicular growth was most closely correlated with increasing peripheral blood oestrogen levels. In 16 women who had a laparoscopy within 12 hours of the last ultrasound and following the LH peak, the mean diameter of the largest follicle as measured by ultrasound (23.6±0.4 mm) was similar to that measured at laparoscopy (22.8±0.4 mm) and estimated from the volume of follicular fluid aspirated (average 5.8±0.2 ml), 22.5 mm. The follicular fluid levels of progesterone were high on the day of the LH peak and blood progesterone levels had risen significantly indicating that luteinization of the dominant Graafian follicles had already occurred prior to ovulation. This study confirms that ultrasonic monitoring provides a reliable measure of follicular growth and allows studies correlating morphological changes with both normal and abnormal endocrine function of the human ovary.

Human luteal phase function following oocyte aspiration from the immediately preovular graafian follicle of spontaneous ovular cycles.

Human luteal phase function as evaluated by peripheral venous blood steroid levels does not appear to be impaired following the aspiration of follicular fluid together with a cumulus enclosed oocyte and a number of granulosal cells from the immediate preovular follicle in women having otherwise spontaneous ovular cycles. The day to day levels of luteinising hormone, oestradiol‐17β, 17α‐hydroxyprogesterone, progesterone and basal temperatures in 14 women who had their preovular follicle aspirated were compared with a control group of 28 spontaneously ovulating women. It was concluded that a carefully performed single aspiration of the contents of a preovular follicle, for the purpose of extra‐corporeal fertilisation of the mature oocyte, did not lead to impaired steroid function of the subsequent corpus luteum, although the prolactin levels were increased due to the effects of the relaxant anaesthetic and/or the laparoscopic procedure. A safe and simple laparoscopic procedure is also described, which is particularly suitable for women with a likelihood of extensive pelvic adhesions.

INCIDENCE OF MULTIPLE PREGNANCY AFTER IN-VITRO FERTILISATION AND EMBRYO TRANSFER

7 multiple pregnancies occurred in a series of 20 pregnancies after oocyte recovery for in-vitro fertilisation and embryo transfer. After ovarian stimulation with clomiphene alone or with human menopausal gonadotropin, 102 laparoscopies were carried out in 62 women and the ongoing pregnancy rate beyond the first trimester was 17/102 laparoscopies (17%), including 5 sets of twins. 1 triplet and 1 twin pregnancy showed evidence of regression of two sacs and one sac, and both are progressing as singleton pregnancies at 16 and 34 weeks, respectively. 3 abortions occurred at 7, 8, and 9 weeks--a spontaneous abortion rate of 15%. The pregnancy and multiple pregnancy rates after stimulation with clomiphene alone or with human menopausal gonadotropin were comparable, but oocyte pickup based on a knowledge of the duration of the endogenous rise in luteinising hormone, rather than 36 h after administration of human chorionic gonadotropin, increased the pregnancy rate. As the quality and number of embryos transferred to the uterus increased, the risk of multiple pregnancy also rose. Consideration should therefore be given to restricting the number of embryos transferred to limit multiple pregnancies to twins.

TRANSPLACENTAL HÆMORRHAGE IN SPONTANEOUS AND INDUCED ABORTION

Abstract In a series of 387 patients the Kleihauer technique was used to identify fœtal red blood-cells within the maternal circulation following spontaneous abortion and termination of pregnancy. The incidence of transplacental haemorrhage for spontaneous abortion was around 6%; but no significant haemorrhage (over 5 cells per 100 low-power fields) was noted in the 166 cases studied. The vaginal (118) and abdominal (103) terminations of pregnancy presented a different picture. Approximately 25% showed evidence of transplacental haemorrhage, which in 3% of cases reached or exceeded the amount suggested as potentially immunising (25 cells per 100 low-power fields). There was no difference in the incidence or degree of transplacental haemorrhage between terminations by the vaginal or abdominal route.

Ageing and fertility

To examine whether fecundity is affected by age, peripheral oestradiol (E2) measurement and reproductive potential were studied in patients in different age groups receiving ovulation induction prior to in vitro fertilization (IVF) and embryo transfer (ET). The term pregnancy rate of 179 patients who had reversal of sterilization following 4 different sterilization procedures was also assessed in similar age groups. In the IVF group, age did not influence maximal E2 rise prior to oocyte retrieval, number of oocytes available for fertilization, fertilization rate, miscarriage or clinical pregnancy rate up to the age of 40. Similarly, in the reversal of sterilization group, term pregnancy rate was not affected by age, but was affected by the method of sterilization originally performed.We conclude from this study that IVF and reversal of sterilization procedures may be successful in women in the later reproductive age group.

Preovulation: Variability, Prediction And Fertility Potential

The time of ovulation may be associated with such subjective physical symptoms as mid-cycle abdo-minal pain, increased awareness of cervical mucus and minor vaginal blood loss.